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Yoon, Hyun, Kwon, Kim, and Bae: Prognostic Significance of Descending Thoracic Aorta Intima-Media Thickness in Patients with Coronary Atherosclerosis
Original Article
Korean Circulation Journal

Korean Circulation Journal 2007; 37(8): 365-372.

Published online: 31 August 2007

DOI: https://doi.org/10.4070/kcj.2007.37.8.365

Prognostic Significance of Descending Thoracic Aorta Intima-Media Thickness in Patients with Coronary Atherosclerosis

Hyun-Ju Yoon, MD, Dae-Woo Hyun, MD, Taek-Geun Kwon, MD, Ki-Hong Kim, MD, Jang-Ho Bae, MD

Division of Cardiology, Heart Center, College of Medicine, Konyang University, Daejeon, Korea.

Corresponding author (janghobae@yahoo.co.kr)

Received 19 February 2007       Accepted 23 May 2007

© 2007, The Korean Society of Circulation

Abstract

Background and Objectives

While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease.

Subjects and Methods

A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50±21 months.

Results

Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, ≤2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p=0.009) than those having lower IMT values (n=55, ≤0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046).

Conclusion

This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT.

Keywords: Aorta, Carotid arteries, Atherosclerosis

Figures and Tables

Fig. 1
Descending thoracic aorta IMT was measured in the most thickened wall in the field visualized in end-diastole, except in the area of plaques. The descending aorta was focused upon in the far wall and again a 1 cm long segment was measured at 2mm intervals. The average value of each of the six IMT measurements of the descending thoracic aorta was taken as the evaluable IMT of the aorta. IMT: intima-media thickness.
kcj-37-365-g001
Fig. 2
Incidence of major adverse cardiovascular event according to the descending thoracic IMT (A) and carotid IMT (B). Base on the descending thoracic aorta IMT mean values, subjects were grouped into high (n=44, ≤0.21 mm) and low IMT (n=60, >0.21 mm). *: statistically significant difference at the 0.05 levels. IMT: intima-media thickness, CHF: congestive heart failure, MI: myocardial infaction, CKD: chronic kidney disease, PVD: peripheral vascular disease.
kcj-37-365-g002
Fig. 3
Kaplan-Meier curves for event free survival associated with stroke (A), peripheral vascular disease (B), and death (C). Base on the descending thoracic aorta IMT mean values, subjects were grouped into high (n=44, ≤0.21 mm, marked as blanked circle) and low IMT (n=60, >0.21 mm, marked as blanked square). IMT: intima-media thickness.
kcj-37-365-g003
Fig. 4
Incidence of major adverse cardiovascular event according to the descending thoracic aorta plaque (A) and carotid plaque (B). Base on the presence of descending thoracic aorta plaque, subjects were grouped into present plaque (n=43) and absent plaque (n=61). *: statistically significant difference at the 0.05 levels. CHF: congestive heart failure, MI: myocardial infarction, CKD: chronic kidney disease, PVD: peripheral vascular disease.
kcj-37-365-g004
Fig. 5
Kaplan-Meier curves for event free survival associated with stroke (A), peripheral vascular disease (B), and death (C). Base on the presence of descending thoracic aorta plaque, subjects were grouped into present plaque (n=43, marked as blanked circle) and absent plaque (n=61, marked as blanked triangle).
kcj-37-365-g005
Table 1
Clinical characteristics of the study according to the intima-media thickness of descending thoracic aorta
kcj-37-365-i001

Data were expressed as mean±1 standard deviation. IMT: intima-media thickness, H(L)DL: high(low)-density lipoprotein, LV: left ventricle, PCI: percutaneous coronary intervention

Table 2
Adjusted odds ratio with 95% confidence intervals for stroke
kcj-37-365-i002

CI: confidence interval, IMT: intima-media thickness, PCI: percutaneous coronary intervention

Table 3
Adjusted odds ratio with 95% confidence intervals for peripheral vascular disease
kcj-37-365-i003

CI: confidence interval, IMT: intima-media thickness, PCI: percutaneous coronary intervention

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